Newswise — People with alcohol use disorder (AUD) have a distorted perception of the richness of imagined future scenarios, according to a study in Alcoholism: Clinical and Experimental Research. The findings could have important implications for AUD treatment and rehabilitation. The ability to imagine specific future events is a type of mental time travel known as episodic future thinking (EFT). EFT contributes to a range of skills needed to safely navigate daily life, including planning, goal-directed behavior, and emotional regulation. Previous research has indicated that people with short-sighted maladaptive behaviors, such as drug misuse and excessive gambling, tend to imagine future events that lack vividness and specificity. Impaired EFT was also suspected to be of clinical importance in AUD, but little was known about the mechanisms underlying the impairment.

The new study involved 40 patients in rehabilitation for AUD, and 40 healthy individuals (controls) who matched the AUD patients in age, education and gender. Participants underwent a range of neurological and psychiatric assessments and completed a future thinking task; this involved thinking of future events and imagining them in as much detail as possible, before orally describing the imagined events and rating different aspects of their own imagined experience. From this task, the researchers could assess two measures of EFT: first, individuals’ own subjective experience of their imagined scenarios, and second, the objective number of reported details in these imagined events, as scored by an independent observer. By comparing the two measures, the research team could determine the extent to which the subjective and objective characteristics of EFT corresponded among both the AUD participants and the controls. The possible impact of cognitive functioning and disturbed mood on EFT measures was also investigated.

The subjective measure showed that those with AUD perceived their imagined future events with similar vividness and detail as the control participants. However, the objective measure showed that the AUD participants provided significantly fewer details about the event (such as happenings, people, time, place, sensory perceptions, thoughts, and emotions) than the non-AUD participants, even when controlling for differences in cognitive functioning. The quantity of reported details was found to correlate with participants’ level of alexithymia (which refers to difficulties in understanding or describing one’s emotions); however, a higher depression score (as often found in AUD) was not associated with either EFT measure.

These results reveal a lower calibration of subjective and objective characteristics of EFT in people with AUD than in healthy participants, and suggest a distorted self-assessment of the richness of imagined future events in AUD. The researchers propose two potential reasons for these differences: poorer metacognitive ability in AUD (i.e. limited awareness and understanding of one's own thought processes), leading to an overestimation of the self-perceived richness of the mental representations, or a compromised ability to verbalize the imagined future events (linked to alexithymic tendencies).

Impaired EFT may contribute to a lack of motivation to stop drinking or stay sober in people with AUD. The current findings therefore support the use of strategies, such as EFT training, to enhance future thinking. Interventions that target the potential mechanisms of EFT impairment, such as metacognitive therapy and strategies to promote verbal expression of the internal imaginary world, could also be helpful in reducing the personal and public health burden of AUD. 

Reduced calibration between subjective and objective measures of episodic future thinking in alcohol use disorder. X. Noel, M. Saeremans, C. Kornreich, A. Chatard, N. Jaafari, A. D'argembeau (pages xxx).


Journal Link: Alcoholism: Clinical and Experimental Research